Article

St. Vincent's offers HOPE for patients with mounting medical bills

When 48-year-old Anne Bloch learned she had breast cancer, she worried that bills for her treatment could financially devastate her family. Her husband had recently lost his job. Her position at the time as a customer service agent didn't provide health insurance, so she only paid for insurance to cover her basic hospitalization costs.

The mother of four anxiously began working the phone, calling doctors' offices and hospital departments looking for financial help with her looming medical costs. She found the Hospital Outreach Patient Eligibility Program at St. Vincent's HealthCare in Jacksonville, Fla. The two-hospital system, which has a third scheduled to open this fall, is part of St. Louis-based Ascension Health.

Under the HOPE program, St. Vincent's financial counselors meet with patients with concerns about their ability to pay their medical bills. The counselors assess the patients' health insurance and financial situation and link them to programs or payment plans that help with the cost of their care. St. Vincent's has found that while many low-income patients qualify for some type of aid or government insurance, the majority don't even know they are eligible.

"It meant the world to me to find out about this program," Bloch says. She applied to HOPE, qualified for Medicaid and had her remaining costs covered as charity care. Without the program, her medical bills to date since her diagnosis would have cost her about $275,000, she says. "I don't know what people would do, other than file for bankruptcy," she says.

A snapshot of the situation
When patients come to HOPE seeking financial options, they first provide a financial specialist with a form of identification; household income information, like pay stubs or unemployment letters; and proof of certain assets. They do not need to provide asset information on their primary residence, under Florida law.

Rachel O'Quinn, a financial specialist for St. Vincent's HealthCare, says this initial document collection "provides a snapshot of where they're at." At the outset, she or another specialist asks patients a series of questions to determine if they qualify for charity care, Medicaid, COBRA coverage, a reduction of their bills or a payment plan.

St. Vincent's Chief Financial Officer Mark Doyle says HOPE staff watch for five Medicaid triggers. If a woman is pregnant or if a person has a child under the age of 21 living at home with them, or is blind, or disabled, or over the age of 65, and is at 150 percent of the federal poverty line, financial counselors will help the person fill out a Medicaid application. St. Vincent's has found that

60 percent of the patients who qualify for Medicaid didn't even know they were eligible to receive assistance.

For patients who don't qualify for Medicaid, the counselors offer options like payment plans or charity care applications. Doyle says, "We approach it as, 'We're here to help. We understand you don't have health insurance; however, we do have several programs that we think can assist you with any medical bills that may be forthcoming.'"

If a patient is still hospitalized, HOPE counselors first ask about the quality of care and patient satisfaction before introducing the subject of financial assistance programs. Doyle says the intent is "to make sure they are comfortable and their needs are being met before introducing the topic of paying for their care."

Converting to Medicaid
O'Quinn says many of those who contact HOPE don't have regular access to physicians and dentists and instead visit emergency rooms for treatment. She says the HOPE office sees about 30 walk-ins and gets about 40 phone calls daily. It receives about 300 or 400 applications from the emergency room weekly. The HOPE program has 12 full-time associates, many of whom are bilingual. About half of the staff members meet face-to-face with patients; the remainder work clerical and administrative functions, such as submitting electronic applications and following up to make sure all needed information is received. Off-site counselors located at a call center also assist with the phone callers.

Doyle says while HOPE assists numerous people, St. Vincent's hasn't been overwhelmed by the cost of helping uninsured patients through the program, in large part because HOPE often can identify a payer for patients' care. Doyle says HOPE staff often can identify people who qualify for Medicaid that another hospital might not have identified without the same screening process and methods to assist patients with the applications. "The money that we've been able to generate converting self-pay to Medicaid essentially offsets the risk," he explains.

Before HOPE started, St. Vincent's two hospitals would convert about $200,000 a month of unpaid balances from self-pay into Medicaid. "Now we're doing on average about $1.8 million a month from self-pay into Medicaid," says Doyle. He says St. Vincent's bad debt has decreased from 8 percent to 6 percent of net patient service revenue. St. Vincent's charity care has increased to about $85 million a year, which he says is up from about $55 million since the HOPE program began in 2011. Prior to the HOPE program, most of these same charity patients would have been sent to collections.

Doyle says other Ascension Health hospitals are beginning HOPE programs this year, including those in Pensacola, Fla.; Mobile and Birmingham, Ala.; and Tuscon, Ariz. Doyle says the program's ability to identify people who qualify for Medicaid is critical at a time when many states will be expanding Medicaid coverage under the Affordable Care Act (Florida legislators have not moved forward with expanding eligibility parameters for Medicaid). He explains, "It's not like any of these new Medicaid recipients are just going to get a card in the mail stating: 'You now have Medicaid.' They're going to have to go through an application process, and that can be most confusing at times." Doyle says the HOPE counselors can help people navigate through the application process.

A mission fit
Doyle says HOPE fits with the system's mission to treat the vulnerable, sick and weak, or as he puts it: "No patient left behind." That's why St. Vincent's proactively informs patients that HOPE's services are available. St. Vincent's displays posters and brochures about the program in the emergency rooms of its St. Vincent's Medical Center Riverside and St. Vincent's Medical Center Southside, both located in Jacksonville. St. Vincent's also provides the posters and brochures to physicians' offices, churches, the YMCA and women's shelters — places in the region where people might be looking for information about access to health care or paying medical bills. The program's office is in a busy area right off the main lobby at each hospital, with plans for a third location when St. Vincent's Clay County opens later this year.

As Doyle explains, it's standard for hospitals to have a cashier's office where patients can get information about their bills and programs where they can find out if they're eligible for Medicaid. However at many other hospitals, he says, patients have to know to ask about assistance programs to learn what's available to them. "With everyone else, it's kind of the Wizard of Oz behind the curtain. You don't know it's there; they don't want you to see it," he says.

Patient Bloch says the assistance she has received from the HOPE counselors has provided some mental relief at she moves forward with her care. She completed chemotherapy, is undergoing reconstructive surgery and still faces an operation to have her ovaries removed after genetic counseling showed elevated risk for ovarian cancer. But she says knowing that the HOPE program has enabled her to get the care she needs is key. As a HOPE patient with her health care bills satisfied, "I can focus on what I need to do to take care of myself," Bloch says.